51
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Perkins A, Trimmier M, Liu G. Selected Disorders of the Nervous System. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_75-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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52
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Lakhani M, Memon RS, Khan F. Brain abscess: A rare complication in a child with tetralogy of Fallot. IDCases 2020; 22:e00954. [PMID: 32995272 PMCID: PMC7501428 DOI: 10.1016/j.idcr.2020.e00954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/06/2020] [Accepted: 09/07/2020] [Indexed: 11/26/2022] Open
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53
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Pourkia R, Hassani SH, Mouodi S. Sinus venosus atrial septal defect presenting with brain abscess in a 33-year-old man. J Cardiovasc Thorac Res 2019; 11:322-324. [PMID: 31824616 PMCID: PMC6891039 DOI: 10.15171/jcvtr.2019.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 08/26/2019] [Indexed: 11/23/2022] Open
Abstract
This study aimed to present a case of 33-year old man who was admitted with a history of one week headache and acute diplopia. No important finding was reported in his past medical history. Brain CT-scan revealed a large mass lesion in left parieto-occipital area with prominent vasogenic edema and midline shift. Brain magnetic resonance imaging (MRI) showed a mass with size of 5*4*5 centimeter with ring enhancement. After cranial surgery and removing the mass, transthoracic and transesophageal echocardiography (TEE) were conducted to find the source of brain abscess. Right ventricular (RV) and right atrial (RA) enlargement, significant left to right shunt, normal left ventricular (LV) and RV function, bidirectional shunt in addition to moderate size superior sinus venosus type atrial septal defect (ASD) were detected. Considering that most of brain abscesses have hematogenous source, a complete cardiac evaluation including TEE with contrast study is suggested for evaluation of patients with brain abscess.
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Affiliation(s)
- Roghayeh Pourkia
- Department of Cardiology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Seyed Habibollah Hassani
- Department of Neurosurgery, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Simin Mouodi
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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54
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Gillespie CS, McMahon CJ. Iatrogenic cerebral abscess leading to resolution of severe delusional disorder. BMJ Case Rep 2019; 12:12/12/e232394. [PMID: 31796437 PMCID: PMC7001695 DOI: 10.1136/bcr-2019-232394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
A cerebral abscess (focal infection of brain parenchyma) carries a high mortality and morbidity. Iatrogenic cerebral abscesses are less common and make up 10% of all cases. The presence of a cerebral abscess can rarely improve a patient's prognosis and quality of life, however this case illustrates an abscess and its treatment following a prolonged course of antibiotics leading to resolution of a severe psychotic disorder. This is a case report of a 32-year-old female inpatient at a psychiatric hospital with a long-standing history of congenital hydrocephalus, cerebral palsy and organic delusional disorder who developed an iatrogenic cerebral abscess after insertion of an implantable intracranial pressure monitoring device. After receiving treatment of 6 weeks of intravenous meropenem the patient's mental condition rapidly improved, she became stable and euthymic and was discharged home. The patient has since had no delusions or hallucinations and is living independently at home.
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Affiliation(s)
- Conor Sn Gillespie
- Department of Neurosurgery, Walton Centre for Neurology and Neurosurgery, Liverpool, UK .,School of Medicine, University of Liverpool, Liverpool, UK
| | - Catherine J McMahon
- Department of Neurosurgery, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
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55
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Dey R, Bishayi B. Dexamethasone exhibits its anti-inflammatory effects in S. aureus induced microglial inflammation via modulating TLR-2 and glucocorticoid receptor expression. Int Immunopharmacol 2019; 75:105806. [PMID: 31401378 DOI: 10.1016/j.intimp.2019.105806] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 07/30/2019] [Accepted: 08/01/2019] [Indexed: 01/31/2023]
Abstract
Microglial inflammation plays crucial role in the pathogenesis of CNS infections including brain abscesses. Staphylococcus aureus (S. aureus) is considered as one of the major causative agents of brain abscesses. Due to the emergence of multidrug resistant bacteria the available treatment options including conventional antibiotics and steroid therapy become ineffective in terms of inflammation regulation which warrants further investigation to resolve this health issue. Microglial TLR-2 plays important roles in the bacterial recognition as well as induction of inflammation whereas glucocorticoid receptor (GR) triggers anti-inflammatory pathways in presence of glucocorticoids (GCs). The main objective of this study was to figure out the interdependency between TLR-2 and GR in presence of exogenous dexamethasone during microglial inflammation as an alternative therapeutic approach. Experiments were done either in TLR-2 neutralized condition or GR blocked condition in presence of dexamethasone. Free radicals production, arginase, superoxide dismutase (SOD), catalase enzyme activities and corticosterone concentration were measured along with Western blot analysis of TLR-2, GR and other inflammatory molecules. The results suggested that dexamethasone pre-treatment in TLR-2 neutralized condition efficiently reduces the inflammatory consequences of S. aureus induced microglial inflammation through up regulating GR expression. During TLR-2 blocking dexamethasone exerted its potent anti-inflammatory activities via suppressing reactive oxygen species (ROS), NO production and up regulating arginase, SOD and catalase activities at the time point of 90 min. Further in-vivo experiments are needed to conclude that dexamethasone could resolve brain inflammation possibly through microglial phenotypic switching from pro-inflammatory M1 to anti-inflammatory M2.
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Affiliation(s)
- Rajen Dey
- Department of Physiology, Immunology Laboratory, University of Calcutta, University College of Science and Technology, Calcutta, West Bengal, India
| | - Biswadev Bishayi
- Department of Physiology, Immunology Laboratory, University of Calcutta, University College of Science and Technology, Calcutta, West Bengal, India.
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56
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Multiple brain abscesses treated by extraction of the maxillary molars with chronic apical lesion to remove the source of infection. Maxillofac Plast Reconstr Surg 2019; 41:25. [PMID: 31321221 PMCID: PMC6606678 DOI: 10.1186/s40902-019-0208-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/11/2019] [Indexed: 11/18/2022] Open
Abstract
Background Brain abscess is a life-threatening condition that occurs due to complications during a neurosurgical procedure, direct cranial trauma, or the presence of local or distal infection. Infection in the oral cavity can also be considered a source of brain abscess. Case presentation A 45-year-old male patient was transported with brain abscess in the subcortical white matter. Navigation-guided abscess aspiration and drainage was performed in the right mid-frontal lobe, but the symptoms continued to worsen after the procedure. A panoramic radiograph showed alveolar bone resorption around the maxillary molars. The compromised maxillary molars were extracted under local anesthesia, and antibiotics were applied based on findings from bacterial culture. A brain MRI confirmed that the three brain abscesses in the frontal lobe were reduced in size, and the patient’s symptoms began to improve after the extractions. Conclusion This is a rare case report about multiple uncontrolled brain abscesses treated by removal of infection through the extraction of maxillary molars with odontogenic infection. Untreated odontogenic infection can also be considered a cause of brain abscess. Therefore, it is necessary to recognize the possibility that untreated odontogenic infection can lead to serious systemic inflammatory diseases such as brain abscess. Through a multidisciplinary approach to diagnosis and treatment, physicians should be encouraged to consider odontogenic infections as a potential cause of brain abscesses.
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57
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Schott HC, Esser MM, Pirie CG, Pease AP, Patterson JS, Reed SM. Long‐term successful outcome of a
Streptococcus equi
subspecies
equi
brain abscess. EQUINE VET EDUC 2019. [DOI: 10.1111/eve.13111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- H. C. Schott
- Department of Large Animal Clinical Sciences College of Veterinary Medicine Michigan State University East Lansing Michigan USA
| | - M. M. Esser
- Department of Large Animal Clinical Sciences College of Veterinary Medicine Michigan State University East Lansing Michigan USA
| | - C. G. Pirie
- Department of Small Animal Clinical Sciences College of Veterinary Medicine Michigan State University East Lansing Michigan USA
| | - A. P. Pease
- Department of Small Animal Clinical Sciences College of Veterinary Medicine Michigan State University East Lansing Michigan USA
| | - J. S. Patterson
- Veterinary Diagnostic Laboratory College of Veterinary Medicine Michigan State University East Lansing Michigan USA
| | - S. M. Reed
- Rood and Riddle Equine Hospital Lexington Lexington Kentucky USA
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58
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Siddiqui H, Vakil S, Hassan M. Diagnostic Accuracy of Echo-planar Diffusion-weighted Imaging in the Diagnosis of Intra-cerebral Abscess by Taking Histopathological Findings as the Gold Standard. Cureus 2019; 11:e4677. [PMID: 31328068 PMCID: PMC6634348 DOI: 10.7759/cureus.4677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/16/2019] [Indexed: 11/05/2022] Open
Abstract
Objective To determine the diagnostic accuracy of echo-planar diffusion-weighted imaging (DWI) in the diagnosis of intra-cerebral abscesses by taking histopathological findings as the gold standard. Subject and methods A retrospective cross-sectional study was performed from July 2014 to June 2015 at a tertiary care hospital in Karachi. A total of 462 patients, who were referred for magnetic resonance imaging (MRI) brain, presenting with clinical suspicion of an intra-cerebral abscess on the basis of clinical signs and symptoms, were included in this study. MR imaging was performed. All patients subsequently underwent surgery. The histopathological findings of these patients were collected and compared with echo-planar diffusion-weighted MRI findings. A proforma was used to record the findings. Results The mean age of the patients was 47.39±13.54 years. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of echo-planar diffusion-weighted MRI in the diagnosis of intra-cerebral abscesses was 85.64%, 95.88%, 93.82%, 90.14%, and 91.56%, respectively. Conclusion Brain abscesses and necrotic tumors are, most of the time, difficult to differentiate on routine conventional imaging, and prompt diagnosis is important, as an untreated brain abscess could be lethal. Diffusion imaging can aid in the diagnosis and further management plan so as to help in improved patient care. Although this sequence has high sensitivity and specificity, it should be used in addition to conventional imaging and not as a replacement of histopathology.
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Affiliation(s)
- Hina Siddiqui
- Radiology, Dow University of Health Sciences (DUHS), Karachi, PAK
| | - Sameera Vakil
- Radiology, Dow University of Health Sciences (DUHS), Karachi, PAK
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59
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Shih CH, Chen JK, Kuo LW, Cho KH, Hsiao TC, Lin ZW, Lin YS, Kang JH, Lo YC, Chuang KJ, Cheng TJ, Chuang HC. Chronic pulmonary exposure to traffic-related fine particulate matter causes brain impairment in adult rats. Part Fibre Toxicol 2018; 15:44. [PMID: 30413208 PMCID: PMC6234801 DOI: 10.1186/s12989-018-0281-1 10.1186/s12989-018-0281-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Effects of air pollution on neurotoxicity and behavioral alterations have been reported. The objective of this study was to investigate the pathophysiology caused by particulate matter (PM) in the brain. We examined the effects of traffic-related particulate matter with an aerodynamic diameter of < 1 μm (PM1), high-efficiency particulate air (HEPA)-filtered air, and clean air on the brain structure, behavioral changes, brainwaves, and bioreactivity of the brain (cortex, cerebellum, and hippocampus), olfactory bulb, and serum after 3 and 6 months of whole-body exposure in 6-month-old Sprague Dawley rats. RESULTS The rats were exposed to 16.3 ± 8.2 (4.7~ 68.8) μg/m3 of PM1 during the study period. An MRI analysis showed that whole-brain and hippocampal volumes increased with 3 and 6 months of PM1 exposure. A short-term memory deficiency occurred with 3 months of exposure to PM1 as determined by a novel object recognition (NOR) task, but there were no significant changes in motor functions. There were no changes in frequency bands or multiscale entropy of brainwaves. Exposure to 3 months of PM1 increased 8-isoporstance in the cortex, cerebellum, and hippocampus as well as hippocampal inflammation (interleukin (IL)-6), but not in the olfactory bulb. Systemic CCL11 (at 3 and 6 months) and IL-4 (at 6 months) increased after PM1 exposure. Light chain 3 (LC3) expression increased in the hippocampus after 6 months of exposure. Spongiosis and neuronal shrinkage were observed in the cortex, cerebellum, and hippocampus (neuronal shrinkage) after exposure to air pollution. Additionally, microabscesses were observed in the cortex after 6 months of PM1 exposure. CONCLUSIONS Our study first observed cerebral edema and brain impairment in adult rats after chronic exposure to traffic-related air pollution.
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Affiliation(s)
- Chi-Hsiang Shih
- 0000 0000 9337 0481grid.412896.0School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jen-Kun Chen
- 0000000406229172grid.59784.37Institute of Biomedical Engineering & Nanomedicine, National Health Research Institutes, Miaoli, Taiwan
| | - Li-Wei Kuo
- 0000000406229172grid.59784.37Institute of Biomedical Engineering & Nanomedicine, National Health Research Institutes, Miaoli, Taiwan
| | - Kuan-Hung Cho
- 0000000406229172grid.59784.37Institute of Biomedical Engineering & Nanomedicine, National Health Research Institutes, Miaoli, Taiwan
| | - Ta-Chih Hsiao
- 0000 0004 0546 0241grid.19188.39Graduate Institute of Environmental Engineering, National Taiwan University, Taipei, Taiwan
| | - Zhe-Wei Lin
- 0000 0000 9337 0481grid.412896.0School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Syuan Lin
- 0000 0000 9337 0481grid.412896.0School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jiunn-Horng Kang
- 0000 0004 0639 0994grid.412897.1Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan ,0000 0000 9337 0481grid.412896.0Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chun Lo
- 0000 0000 9337 0481grid.412896.0The Ph.D Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Kai-Jen Chuang
- 0000 0000 9337 0481grid.412896.0School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan ,0000 0000 9337 0481grid.412896.0Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tsun-Jen Cheng
- 0000 0004 0546 0241grid.19188.39Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hsiao-Chi Chuang
- 0000 0000 9337 0481grid.412896.0School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan ,0000 0000 9337 0481grid.412896.0School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan ,0000 0000 9337 0481grid.412896.0Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
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60
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Shih CH, Chen JK, Kuo LW, Cho KH, Hsiao TC, Lin ZW, Lin YS, Kang JH, Lo YC, Chuang KJ, Cheng TJ, Chuang HC. Chronic pulmonary exposure to traffic-related fine particulate matter causes brain impairment in adult rats. Part Fibre Toxicol 2018; 15:44. [PMID: 30413208 PMCID: PMC6234801 DOI: 10.1186/s12989-018-0281-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/24/2018] [Indexed: 11/30/2022] Open
Abstract
Background Effects of air pollution on neurotoxicity and behavioral alterations have been reported. The objective of this study was to investigate the pathophysiology caused by particulate matter (PM) in the brain. We examined the effects of traffic-related particulate matter with an aerodynamic diameter of < 1 μm (PM1), high-efficiency particulate air (HEPA)-filtered air, and clean air on the brain structure, behavioral changes, brainwaves, and bioreactivity of the brain (cortex, cerebellum, and hippocampus), olfactory bulb, and serum after 3 and 6 months of whole-body exposure in 6-month-old Sprague Dawley rats. Results The rats were exposed to 16.3 ± 8.2 (4.7~ 68.8) μg/m3 of PM1 during the study period. An MRI analysis showed that whole-brain and hippocampal volumes increased with 3 and 6 months of PM1 exposure. A short-term memory deficiency occurred with 3 months of exposure to PM1 as determined by a novel object recognition (NOR) task, but there were no significant changes in motor functions. There were no changes in frequency bands or multiscale entropy of brainwaves. Exposure to 3 months of PM1 increased 8-isoporstance in the cortex, cerebellum, and hippocampus as well as hippocampal inflammation (interleukin (IL)-6), but not in the olfactory bulb. Systemic CCL11 (at 3 and 6 months) and IL-4 (at 6 months) increased after PM1 exposure. Light chain 3 (LC3) expression increased in the hippocampus after 6 months of exposure. Spongiosis and neuronal shrinkage were observed in the cortex, cerebellum, and hippocampus (neuronal shrinkage) after exposure to air pollution. Additionally, microabscesses were observed in the cortex after 6 months of PM1 exposure. Conclusions Our study first observed cerebral edema and brain impairment in adult rats after chronic exposure to traffic-related air pollution. Electronic supplementary material The online version of this article (10.1186/s12989-018-0281-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chi-Hsiang Shih
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jen-Kun Chen
- Institute of Biomedical Engineering & Nanomedicine, National Health Research Institutes, Miaoli, Taiwan
| | - Li-Wei Kuo
- Institute of Biomedical Engineering & Nanomedicine, National Health Research Institutes, Miaoli, Taiwan
| | - Kuan-Hung Cho
- Institute of Biomedical Engineering & Nanomedicine, National Health Research Institutes, Miaoli, Taiwan
| | - Ta-Chih Hsiao
- Graduate Institute of Environmental Engineering, National Taiwan University, Taipei, Taiwan
| | - Zhe-Wei Lin
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Syuan Lin
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jiunn-Horng Kang
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chun Lo
- The Ph.D Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Kai-Jen Chuang
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.,Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tsun-Jen Cheng
- Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hsiao-Chi Chuang
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan. .,Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
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61
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Erbasan F. Brain abscess caused by Micrococcus luteus in a patient with systemic lupus erythematosus: case-based review. Rheumatol Int 2018; 38:2323-2328. [PMID: 30374688 DOI: 10.1007/s00296-018-4182-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 10/20/2018] [Indexed: 12/13/2022]
Abstract
Central nervous system infections, which are rarely seen in systemic lupus erythematosus (SLE), have considerably high mortality but they are difficult to distinguish from neuropsychiatric manifestation of lupus. This article reports the case of a patient with SLE with brain abscess which developed during immunosuppressive therapy for lupus nephritis. The patient completely recovered without neurological sequelae by open surgical drainage and 12-week antibiotic therapy. It is recommended that CNS infections must be excluded in patients with SLE, particularly who are receiving immunosuppressive therapy.
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Affiliation(s)
- Funda Erbasan
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Akdeniz University, Antalya, Turkey.
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62
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Mathais Q, Esnault P, Montcriol A, Gazzola S, Prunet B, Meaudre E. Locked-in syndrome following meningitis with brainstem abscess. Rev Neurol (Paris) 2018; 175:88-89. [PMID: 30274815 DOI: 10.1016/j.neurol.2018.01.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/05/2018] [Accepted: 01/11/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Q Mathais
- Department of Anesthesiology and Intensive Care, Military Hospital Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83000 Toulon, France.
| | - P Esnault
- Department of Anesthesiology and Intensive Care, Military Hospital Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83000 Toulon, France
| | - A Montcriol
- Department of Anesthesiology and Intensive Care, Military Hospital Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83000 Toulon, France
| | - S Gazzola
- Department of Neurology, Military Hospital Sainte-Anne, 83000 Toulon, France
| | - B Prunet
- Department of Anesthesiology and Intensive Care, Military Hospital Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83000 Toulon, France
| | - E Meaudre
- Department of Anesthesiology and Intensive Care, Military Hospital Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83000 Toulon, France; École du Val de Grâce, 75230 Paris, France
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63
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Lovett ME, Shah ZS, Moore-Clingenpeel M, Sribnick E, Ostendorf A, Chung MG, Leonard J, O'Brien NF. Intensive care resources required to care for critically ill children with focal intracranial infections. J Neurosurg Pediatr 2018; 22:453-461. [PMID: 30004311 DOI: 10.3171/2018.4.peds17715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The authors reviewed cases in which children with a focal infection inside the head (ex: a brain abscess) were cared for in their pediatric ICU to describe the frequency of complications and quantify the ICU resources needed (ex: breathing tube, blood pressure medications, and/or an intracranial pressure monitor). This information helps clarify illness severity and has identified complications that we should further investigate to improve care for these children.
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Affiliation(s)
- Marlina E Lovett
- 1Division of Critical Care Medicine, Nationwide Children's Hospital.,2Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine
| | - Zubin S Shah
- 2Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine
| | | | - Eric Sribnick
- 4Division of Neurosurgery, Nationwide Children's Hospital; and
| | - Adam Ostendorf
- 2Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine.,5Division of Neurology, Nationwide Children's Hospital, Columbus, Ohio
| | - Melissa G Chung
- 1Division of Critical Care Medicine, Nationwide Children's Hospital.,2Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine.,5Division of Neurology, Nationwide Children's Hospital, Columbus, Ohio
| | - Jeffrey Leonard
- 4Division of Neurosurgery, Nationwide Children's Hospital; and
| | - Nicole F O'Brien
- 1Division of Critical Care Medicine, Nationwide Children's Hospital.,2Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine
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64
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Lange N, Berndt M, Jörger AK, Wagner A, Wantia N, Lummel N, Ryang YM, Meyer B, Gempt J. Clinical characteristics and course of primary brain abscess. Acta Neurochir (Wien) 2018; 160:2055-2062. [PMID: 30069602 DOI: 10.1007/s00701-018-3633-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/19/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Due to improved diagnostic methods, the incidence of brain abscess is still rising. Therefore, clear and evidence-based therapy for the patients who suffer from brain abscesses is necessary. Brain abscesses are potentially life-threatening conditions that possibly lead to permanent injuries even after sufficient healing has taken place. The aims of this study were to analyze the clinical aspects of patients with brain abscesses and thereby to reveal the relevant aspects for the future treatment of the brain lesions. METHODS We retrospectively identified 47 patients (24 male, 23 female) who had received surgery or undergone the frameless stereotactic drainage of brain abscesses in our center from March 2009 to May 2017. We analyzed the clinical characteristics of the patients, as well as comorbidities and outcomes. RESULTS The mean age was 58 (range 7 to 86). Focus identification was successful in 28 patients (60%), with the most frequent causes of brain abscesses including the following: sinusitis (25%), dental infections (25%), and mastoiditis (21%). The mean Charlson Comorbidity Index was 1.57. Among the patients, 34% showed immunosuppressive conditions. We performed 1.5 surgeries per patient (53% via craniotomy, 28% biopsies or stereotactic drainage, 19% both procedures), followed by antibiotic treatment for 6.5 weeks (mean). In 30% of patients, no bacteria could be isolated. During the follow-up period (a median of 12 months), 23.4% of the patients died. The mortality rate during the initial hospital stay was 4.3%. CONCLUSION One third of the patients with brain abscesses showed immunosuppressive conditions, whereas brain abscesses also often occur in patients with good medical conditions. The isolation of the focus of infection is often possible. Surgical procedures showed very good outcomes. Patients over 60 years showed significantly worse clinical outcomes.
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Affiliation(s)
- Nicole Lange
- Neurosurgical Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Maria Berndt
- Neuroradiological Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Ann-Kathrin Jörger
- Neurosurgical Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Arthur Wagner
- Neurosurgical Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Nina Wantia
- Microbiological Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Nina Lummel
- Neuroradiological Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Yu-Mi Ryang
- Neurosurgical Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bernhard Meyer
- Neurosurgical Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jens Gempt
- Neurosurgical Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
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Nanoscale mechanics of brain abscess: An atomic force microscopy study. Micron 2018; 113:34-40. [PMID: 29957562 DOI: 10.1016/j.micron.2018.06.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 06/19/2018] [Accepted: 06/19/2018] [Indexed: 12/11/2022]
Abstract
Mechanical stimuli are a fundamental player in the pathophysiology of the brain influencing its physiological development and contributing to the onset and progression of many diseases. In some pathological states, the involvement of mechanical and physical stimuli might be extremely subtle; in others, it is more evident and particularly relevant. Among the latter pathologies, one of the most serious life-threatening condition is the brain abscess (BA), a focal infection localized in the brain parenchyma, which causes large brain mechanical deformations, giving rise to a wide range of neurological impairments. In this paper, we present the first nano-mechanical characterization of surgically removed human brain abscess tissues by means of atomic force microscopy (AFM) in the spectroscopy mode. Consistently with previous histological findings, we modeled the brain abscess as a multilayered structure, composed of three main layers: the cerebritis layer, the collagen capsule, and the internal inflammatory border. We probed the viscoelastic behavior of each layer separately through the measure of the apparent Young's modulus (E), that gives information about the sample stiffness, and the AFM hysteresis (H), that estimates the contribution of viscous and dissipative forces. Our experimental findings provide a full mechanical characterization of the abscess, showing an average E of (94 ± 5) kPa and H of 0.37 ± 0.01 for the cerebritis layer, an average E = (1.04 ± 0.05) MPa and H = 0.10 ± 0.01 for the collagen capsule and an average E = (9.8 ± 0.4) kPa and H = 0.57 ± 0.01 for the internal border. The results here presented have the potential to contribute to the development of novel surgical instruments dedicated to the treatment of the pathology and to stimulate the implementation of novel constitutive mechanical models for the estimation of brain compression and damage during BA progression.
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AlHarmi RA, Henari DF, Jadah RHS, AlKhayyat HM. A brain populated with space-occupying lesions: identifying the culprit. BMJ Case Rep 2018; 2018:bcr-2018-224286. [PMID: 29691273 DOI: 10.1136/bcr-2018-224286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This is a case of an 8-year-old girl who was previously healthy and presented with unresponsiveness on a background of fever that resolved within 2 days of onset. History was significant for recurrent dental abscesses requiring drainage. Imaging revealed what was unexpected: a brain overloaded with multiple space-occupying lesions and diffuse oedema. The patient was started on mannitol and dexamethasone in addition to antimicrobials. Her condition improved dramatically within few days. Multiple aspiration procedures were performed later and she recovered fully with minor deficits.
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Affiliation(s)
- Rawan A AlHarmi
- Medical intern, Bahrain Defence Force Royal Medical Services, Riffa, Bahrain
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Frontal sinusitis complicated by a brain abscess and subdural empyema. Radiol Case Rep 2018; 13:456-459. [PMID: 29682134 PMCID: PMC5906865 DOI: 10.1016/j.radcr.2018.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 02/03/2018] [Indexed: 11/23/2022] Open
Abstract
A 49-year-old male was brought to the Emergency Department after being found unresponsive. The patient had multiple seizures and was intubated in the prehospital setting. A computed tomography scan showed bilateral paranasal sinus disease, and magnetic resonance imaging showed a right frontal abscess and subdural empyema. Neurosurgery took the patient to the operating room, performed a craniotomy, and drained a large amount of purulent fluid. He was subsequently discharged for acute rehabilitation. Clinicians should consider complicated frontal sinusitis, especially in the undifferentiated patient presenting with neurologic deficits and signs or symptoms of sinus disease.
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Hadžimuratović E, Hadžimuratović A, Hadžipašić A. Multiple brain abscesses caused by Serratia marcescens in preterm newborn. CASE REPORTS IN PERINATAL MEDICINE 2018. [DOI: 10.1515/crpm-2017-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Brain abscesses are possible but very uncommon complications of bacterial sepsis and meningitis in neonates. We report a case of multiple brain abscesses in a preterm neonate as a complication of Serratia marcescens sepsis.
Case
The female preterm weighing 1990 g was delivered by cesarean section at 32 weeks of gestation. Apart from moderate respiratory distress syndrome (RDS), the baby was in a good condition with no indicators of perinatal infection. On the 3rd day of life, the clinical status deteriorated and the sepsis screen was positive. The baby was intubated and, along with other intensive measures, treated with high doses of vancomycin and imipenem. Serattia marcescens was isolated in hemoculture. The baby clinicaly improved in the following days, but the cranial ultrasound revealed multiple hypoechoic lesions in parietal lobes bilaterally. Magnetic resonance imaging (MRI) of the brain showed multiple (five) hypodense lesions with the peripheral enhancement suggestive of intra-parenchymal abscesses. The neurosurgical consilium suggested conservative treatment with antibiotics and weekly neuroimiging follow-up. The antibiotic treatment was conducted for a total of 8 weeks. The final MRI showed a total regresion of previous abscesses with the formation of small cavitations. The clinical and neurological examination of the baby was normal as was the EEG. The baby was discharged with a recommendation of neurological follow-up.
Conclusion
A multidisciplinary team approach, including neurosurgeons, neonatologists and infectious disease specialists, is needed for a decision on treatment of brain abscesses in neonates. Serial imaging is important in the assessment of the efficacy of treatment.
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Affiliation(s)
- Emina Hadžimuratović
- Pediatric Clinic , University Medical Center Sarajevo , Patriotske lige 81 , 71000 Sarajevo , Bosnia and Herzegovina
| | - Admir Hadžimuratović
- Pediatric Clinic , University Medical Center Sarajevo , 71000 Sarajevo , Bosnia and Herzegovina
| | - Amra Hadžipašić
- Public Institution Health Centar of Sarajevo Canton , 71000 Sarajevo , Bosnia and Herzegovina
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de Sousa M, Lança A, Sepúlveda C, Pereira E. Brain abscess in a patient with chronic sinusitis. BMJ Case Rep 2018; 2018:bcr-2017-223266. [DOI: 10.1136/bcr-2017-223266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lee HS, Kim JH, Kim YH, Lee S. Surgically Treated Community-Acquired Brain Abscess: Bacteriological Analysis Based on Predisposing Infections. Jpn J Infect Dis 2018; 71:191-196. [DOI: 10.7883/yoken.jjid.2017.425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Jeong Hoon Kim
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center
| | - Young-Hoon Kim
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center
| | - Seungjoo Lee
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center
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71
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Gonzales Zamora JA, Espinoza LA. Pyogenic Brain Abscess Caused by Peptostreptococcus in a Patient with HIV-1 Infection. Diseases 2017; 5:diseases5040026. [PMID: 29149022 PMCID: PMC5750537 DOI: 10.3390/diseases5040026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/15/2017] [Accepted: 11/15/2017] [Indexed: 11/16/2022] Open
Abstract
In the setting of HIV, cerebral lesions are usually secondary to lymphoma and opportunistic infections; however, in patients with CD4 counts above 200 cells/uL, other pathologies such as pyogenic brain abscess could gain importance. The microbiology of pyogenic brain abscess has Staphylococcus and Streptococcus as the leading etiologic pathogens in immunocompetent individuals. Peptostreptococcus is also recognized as a common cause of brain abscess in this patient population. In HIV-infected individuals, there have been sporadic reports of Peptostreptococcus infections but none of brain abscess. We describe the case of a 43-years-old HIV-infected patient with a CD4 count of 350 cells/uL that developed a Peptostreptococcus brain abscess presumably from hematogenous spread of an odontogenic source. Treatment with stereotactic needle aspiration in two opportunities and four weeks of intravenous antibiotics led to a complete resolution of this infection. This case highlights the importance of a multidisciplinary approach for an effective treatment of pyogenic brain abscess in HIV-1 patients.
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Affiliation(s)
- Jose Armando Gonzales Zamora
- Division of Infectious Diseases, Department of Medicine, University of Miami, Miller School of Medicine, Miami, FL 33136, USA.
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72
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Carson T, Miulli D. Bedside twist drill aspiration of cerebral abscess less than 2.5 cm in size: A case series and discussion. Surg Neurol Int 2017; 8:230. [PMID: 29026666 PMCID: PMC5629863 DOI: 10.4103/sni.sni_291_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 06/26/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Intracranial abscess remains a potentially deadly condition despite development of newer antibiotics and improved surgical methods. Many studies have evaluated the surgical indications for abscess drainage, and it has been generally accepted that intracranial abscesses greater than 2.5 cm may best be treated with surgical intervention followed by antibiotic therapy. More recently, studies have shown good results with stereotactic aspiration of abscesses to 1 cm in size. Furthermore, a recent case series in 2014 of 103 cases of bedside twist drill aspiration of cerebral abscess >2.5 cm showed a good recovery in 83.4% of cases. CASE DESCRIPTION This case series examines the benefits of bedside twist drill aspiration of peripherally located brain abscess less than 2.5 cm in size. In our series, all patients were placed on broad-spectrum antibiotics and had negative blood and cerebrospinal fluid cultures. Our bedside biopsy resulted in de-escalation of antibiotics in 2 of the 3 patients and decreased hospital length of stay. CONCLUSION In patients with peripherally located brain abscesses less than 2.5 cm in size, bedside twist drill drainage may be a safe and reasonable approach. Positive identification of infective pathogen allows for a decreased hospital length of stay and de-escalation of antibiotics regiment resulting in significant reduction of hospital costs and resources in 2 of the 3 patients treated. This is of benefit to the patient as well as the health system.
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Affiliation(s)
- Tyler Carson
- Department of Neurosurgery, Riverside University Health Systems Medical Center, Moreno Valley, California, USA
- Department of Neurosurgery, Arrowhead Regional Medical Center, Colton, California, USA
| | - Dan Miulli
- Department of Neurosurgery, Riverside University Health Systems Medical Center, Moreno Valley, California, USA
- Department of Neurosurgery, Arrowhead Regional Medical Center, Colton, California, USA
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73
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Liu G, Perkins A. Selected Disorders of the Nervous System. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Infections of the nervous system are an important and challenging aspect of clinical neurology. Immediate correct diagnosis enables to introduce effective therapy, in conditions that without diagnosis may leave the patient with severe neurological incapacitation and sometimes even death. The cerebrospinal fluid (CSF) is a mirror that reflects nervous system pathology and can promote early diagnosis and therapy. The present chapter focuses on the CSF findings in neuro-infections, mainly viral and bacterial. Opening pressure, protein and glucose levels, presence of cells and type of the cellular reaction should be monitored. Other tests can also shed light on the causative agent: serology, culture, staining, molecular techniques such as polymerase chain reaction. Specific examination such as panbacterial and panfungal examinations should be examined when relevant. Our chapter is a guide-text that combines clinical presentation and course with CSF findings as a usuaful tool in diagnosis of neuroinfections.
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Affiliation(s)
- Felix Benninger
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
| | - Israel Steiner
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
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Yüksel MO, Gürbüz MS, Karaarslan N, Caliskan T. Rapidly progressing interhemispheric subdural empyema showing a three-fold increase in size within 12 hours: Case report. Surg Neurol Int 2016; 7:S872-S875. [PMID: 27999711 PMCID: PMC5154207 DOI: 10.4103/2152-7806.194495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 07/28/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Subdural empyema is a rare form of intracranial infection. It is described as accumulation of purulent infective material between the inner layer of dura mater and outer layer of arachnoid membrane. CASE DESCRIPTION A 17-year-old girl was admitted to the emergency department with acute left hemiplegia and was diagnosed with interhemispheric subdural empyema that showed a three-fold increase in size within 12 hours. Complete recovery was achieved with emergency surgical evacuation and additional 3 weeks of antibiotic treatment. CONCLUSION Subdural empyema should be diagnosed and managed early in time since it may progress very rapidly and can cause high morbidity and mortality. Complete recovery can be achieved if it is diagnosed early and treated in time.
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Affiliation(s)
- Mehmet O. Yüksel
- Department of Neurosurgery, Erzurum Bolge Training and Research Hospital, Erzurum, Turkey
| | | | - Numan Karaarslan
- Department of Neurosurgery, Namık Kemal University Faculty of Medicine, Tekirdag, Turkey
| | - Tezcan Caliskan
- Department of Neurosurgery, Namık Kemal University Faculty of Medicine, Tekirdag, Turkey
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76
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Aydın M, Özçelik Ü, Çevik H, Çınar Ö, Evren E, Demirağ A. Multiple Brain Abscesses Due to Phialemonium in a Renal Transplant Recipient: First Case Report in the Literature. EXP CLIN TRANSPLANT 2016; 13 Suppl 3:77-80. [PMID: 26640919 DOI: 10.6002/ect.tdtd2015.p31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Fungal brain abscesses are a rare but serious complication in transplant recipients. Phialemonium organisms are rare causes of invasive mold infections. Here, we present the first case of a renal transplant recipient with multiple brain abscesses caused by Phialemonium infection A. A 51-year-old female kidney transplant recipient was admitted with pneumonia of an unknown cause and treated with empiric intravenous antibiotics. Her treatment was uneventful, and she was discharged 1010 days later. After 5 days, she was readmitted with fever, cerebral palsy, and speech disorder. The patient had undergone living-donor renal transplant 7 months earlier. A cranial computed tomography and magnetic resonance imaging were performed for a possible cerebrovascular pathology. The magnetic resonance imaging scan showed multiple brain abscesses located at the left parietal, frontal and occipital lobes; right parietal and occipital lobes; right basal ganglia; and left cerebellum. The patient received meropenem, linezolid, sulfamethoxazole and trimethoprim, and AmBisome for probable pathogenic infection, and immunosuppressive agents dosage was reduced increasingly immunosuppressed. We identified Phialemonium in cerebrospinal fluid culture. The patient received voriconazole 200 mg twice daily. Lesions could not be drained due to lack of capsula formation. The patient died on the 30th day of antifungal therapy. Phialemonium organisms, although a rare cause of fungal infections, are associated with a high mortality rate in immunocompromised patients. To our knowledge, this is the first case report in the literature describing multiple brain abscesses due to Phialemonium in a transplant recipient. Clinicians recipient should be alert about these rare opportunistic fungi in the differential diagnosis of brain abscess, and bronchoscopy and bronchoalveolar lavage are recommended for transplant patients when they are admitted with pneumonia exclude fungal infections.
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Affiliation(s)
- Mehtap Aydın
- From the Department of Infectious Diseases and Clinical Microbiology, Baskent University School of Medicine, Istanbul, Turkey
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77
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Neurological Symptoms in a Cancer Patient With Osler-Weber-Rendu Syndrome. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2016. [DOI: 10.1097/ipc.0000000000000353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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78
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Anaerobic brain abscess. IRANIAN JOURNAL OF MICROBIOLOGY 2016; 8:120-4. [PMID: 27307977 PMCID: PMC4906718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Brain abscess remains a potentially fatal central nervous system (CNS) disease, especially in developing countries. Anaerobic abscess is difficult to diagnose because of cumbersome procedures associated with the isolation of anaerobes. MATERIALS AND METHODS This is a hospital-based retrospective microbiological analysis of 430 brain abscess materials (purulent aspirates and/or tissue), for anaerobic organisms, that were received between 1987-2014, by the Microbiology Laboratory in our Institute. RESULTS Culture showed growth of bacteria 116/430 (27%) of the cases of which anaerobes were isolated in 48/116 (41.1%) of the cases. Peptostreptococcus (51.4 %), was the predominant organism isolated in four cases followed by Bacteroides and Peptococcus species. CONCLUSION Early diagnosis and detection of these organisms would help in the appropriate management of these patients.
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79
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Zhang Z, Cai X, Li J, Kang X, Wang H, Zhang L, Yan R, Gao N, Liu S, Yue S, Zhang J, Yang S, Yang X. Retrospective analysis of 620 cases of brain abscess in Chinese patients in a single center over a 62-year period. Acta Neurochir (Wien) 2016; 158:733-739. [PMID: 26883550 DOI: 10.1007/s00701-016-2741-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 02/08/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Despite advances in laboratory diagnostics, antibiotic regimens, and neurosurgical techniques, brain abscess (BA) remains a potentially fatal infectious disease. This study analyzed clinical and epidemiological aspects of BA in Chinese patients treated at a single center during a 62-year period. METHOD We retrospectively analyzed 620 BA patients treated at Tianjin Medical University General Hospital, Tianjin, PR China from 1952 to 2014. Because of the initiation of imaging technology use in 1992, and other specific changes, we analyzed data over three study periods: 1952-1972, 1980-1991, and 2002-2014. Information including incidence, sex, age, community distribution, BA size and location, therapeutic method, prognosis and outcome of BA patients was collected and evaluated. RESULTS Our study included 620 BA patients. The percentage mortality significantly decreased from 22.8 % in 1952 to 6.3 % in 2014 (p < 0.001). Although the incidence of BA was higher in males than females, there was no significant change in the male/female incidence ratio over time: 2.5 in 1952-1972, 2.6 in 1980-1991, and 2.2 in 2002-2014. The cryptogenic infection incidence significantly increased over time (p < 0.001). The number of positive bacterial cultures significantly decreased over the three study periods (p < 0.01). CONCLUSIONS The prognosis of patients with BA has gradually improved over the past 62 years in Tianjin, China. This may be because improvements in neurosurgical techniques, cranial imaging, and antimicrobial regimens have facilitated less invasive and more precise neurosurgical procedures.
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Affiliation(s)
- Zhen Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
- Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Xinwang Cai
- Department of Neurosurgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
- Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Jia Li
- Department of Neurosurgery, Baoding No.1 Hospital, Baoding, 071000, People's Republic of China
| | - Xiaokui Kang
- Department of Neurosurgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
- Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Haining Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
- Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Lin Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
- Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Rong Yan
- Department of Neurosurgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
- Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Nannan Gao
- Department of Neurosurgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
- Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Shengjie Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
- Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Shuyuan Yue
- Department of Neurosurgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
- Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Jianning Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
- Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Shuyuan Yang
- Department of Neurosurgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
- Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Xinyu Yang
- Department of Neurosurgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, People's Republic of China.
- Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China.
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80
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A Case of Brain Abscess Caused by Medication-Related Osteonecrosis of the Jaw. Case Rep Dent 2016; 2016:7038618. [PMID: 26949551 PMCID: PMC4754463 DOI: 10.1155/2016/7038618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 01/13/2016] [Accepted: 01/14/2016] [Indexed: 11/17/2022] Open
Abstract
Reports of brain abscesses caused by medication-related osteonecrosis of the jaw (MRONJ) are very rare. We here present the case of a 76-year-old man with terminal-stage prostatic carcinoma and a brain abscess caused by MRONJ at the maxilla. The patient had been treated with zoledronic acid and denosumab for bone metastasis. For the brain abscess, an antibiotic regimen based on ceftriaxone and metronidazole and a sequestrectomy contributed to a successful outcome. In the case of maxillary MRONJ extending to the maxillary sinus, active resection of the infected bone should be considered to prevent the spread of the infection beyond the maxillary sinus, into the ethmoid sinus, and into the brain.
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81
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Hall A, White MAJ, Gallo P. An intra-cerebral abscess in a patient with Eisenmenger syndrome: An unusual case. Int J Surg Case Rep 2016; 20:138-41. [PMID: 26859871 PMCID: PMC4818319 DOI: 10.1016/j.ijscr.2016.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/17/2016] [Accepted: 01/18/2016] [Indexed: 11/25/2022] Open
Abstract
Conservative management alone, in certain cases, can be an effective method of treating large cerebral abscesses that would normally warrant surgical intervention in patients with complex congenital heart conditions. Having an alternative, non-surgical, method of treating large brain abscesses in patients with underlying complex congenital heart conditions, in which brain abscesses is a known complication, is of great clinical importance. Due to the increasing number of patients living longer with congenital heart conditions, further study into the conservative management of larger abscesses is warranted.
Introduction We present an unusual case where a large intra-cerebral abscess with severe complications was treated successfully with medical management alone in a patient with Eisenmenger syndrome. Presentation of case A 40 year old patient with Eisenmenger syndrome presented with a seven day history of headache, neck pain and intermittent vomiting and fever. The only neurological examination finding was blurred vision. MRI revealed a large left occipital lobe abscess, which subsequently ruptured into the lateral ventricle with associated ventriculitis and hydrocephalus. This complicated abscess was successfully treated with intravenous antibiotics alone, with complete resolution of the abscess and hydrocephalus on MRI at 13 months post-diagnosis. Discussion Patients with congenital cyanotic heart conditions, like Eisenmenger syndrome, are at increased risk of developing intra-cerebral abscesses. Effectively managing large abscesses with associated intra-ventricular rupture and hydrocephalus in these patients without any form of surgical intervention, including aspiration, is extremely rare. Conclusion Patients with congenital cyanotic heart disease who develop large intra-cerebral abscesses with severe complications, which would normally warrant surgical intervention, have the potential to be successfully treated with antibiotics alone with excellent outcome.
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Affiliation(s)
- Allan Hall
- Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom.
| | - Mark A J White
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom
| | - Pasquale Gallo
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom
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13N-ammonia combined with 18F-FDG could discriminate between necrotic high-grade gliomas and brain abscess. Clin Nucl Med 2015; 40:195-9. [PMID: 25546194 DOI: 10.1097/rlu.0000000000000649] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Accurate prediction of brain abscess is beneficial for timely management. In this study, we investigated the utility of 13N-ammonia and its combination with 18F-FDG in differentiating brain abscess from necrotic high-grade gliomas. PATIENTS AND METHODS Thirteen patients with ring-like enhancement high-grade gliomas and 11 patients with brain abscess were recruited in our study. All of them underwent both 18F-FDG and 13N-ammonia PET imaging. Lesion uptake was evaluated by lesion to normal gray matter ratio (L/N). Histopathology diagnosis was obtained for all the patients after PET imaging. RESULTS The L/N values of 18F-FDG were not significantly different between brain abscess and necrotic high-grade gliomas (P = 0.35). The uptake of 13N-ammonia in gliomas was higher than that in abscess lesions (L/N: 1.38 ± 0.31 vs 0.84 ± 0.18, P < 0.001). The receiver operating characteristic curve analysis determined the optimal L/N cutoff value (13N-ammonia) of 1.0 with the area under the curve of 0.94 and the overall accuracy of 87.5%. Discriminant analysis demonstrated that the combination of 18F-FDG and 13N-ammonia could distinguish the 2 clinical entities with higher accuracy of 95%, and only 1 necrotic glioma lesion was misclassified into the abscess group. CONCLUSIONS 13N-ammonia is effective in distinguishing brain abscess from necrotic high-grade gliomas, and its combination with 18F-FDG could further elevate the diagnostic accuracy.
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Matas A, Veiga A, Gabriel JP. Brain Abscess due to Staphylococcus lugdunensis in the Absence of Endocarditis or Bacteremia. Case Rep Neurol 2015; 7:1-5. [PMID: 25759658 PMCID: PMC4327556 DOI: 10.1159/000371441] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Staphylococcus lugdunensis has been recognized to be a microorganism potentially more virulent than other coagulase-negative staphylococci. We report the case of a patient who presented with a single, large, right, frontoparietal abscess that evolved despite conventional antibiotic treatment. Bacteremia and endocarditis were excluded. After surgical treatment, S. lugdunensis sensible to trimethoprim-sulfamethoxazole was isolated, and the patient responded favorably to treatment. Although the ability of S. lugdunensis to produce brain abscesses has been recognized, we report a case of a brain abscess in the absence of bacteremia or endocarditis.
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Affiliation(s)
- Andreia Matas
- Centro Hospitalar Trás-os-Montes-e-Alto-Douro, Vila Real, Portugal
| | - Andreia Veiga
- Centro Hospitalar Trás-os-Montes-e-Alto-Douro, Vila Real, Portugal
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Selected Disorders of the Nervous System. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_75-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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85
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Affiliation(s)
- Yk Chew
- Department of Otorhinolaryngology and Head and Neck Surgery, Sultanah Fatimah Specialist Hospital, Muar, Johor, Malaysia
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Sarmast AH. Commentary. J Neurosci Rural Pract 2013; 4:S81-2. [PMID: 24174806 PMCID: PMC3808068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Arif Hussain Sarmast
- Department of Neurosurgery, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, Jammu and Kashmir, India,Address for correspondence: Dr. Arif Hussain Sarmast, Dalipora Kawadara, Srinagar, Kashmir - 190 002, India. E-mail:
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